Letter Reversals

Letter reversals are frequently an area of concern for parents as their child begins to learn writing and reading. Reversals are often viewed as a sign of dyslexia and are surrounded by myth. Here are the facts on letter reversals

Letter reversals are common and appropriate until a child reaches 7 or 8 years old (second grade).
After the age of 7-8, the children who continue to have reversals are the children that are having difficulty with reading(1)
Learning letters is the first time a child learns that an item becomes a different thing based on the way it is facing. A cup from seen from one side or the other is still a cup but a “b” seen the other way (“d”) is not the same thing.
Visual-spatial and left/right body awareness correlated with children having letter reversal problems suggesting that addressing left/right awareness would improve letter reversals (2)
Working memory deficits, also found in dyslexia, were found in children with letter reversals, so addressing working memory may improve letter reversals. (3)
Children with ADHD tend to have more reversals, possibly related to difficulty in an inability to suppress the more natural left-right flow of making most letters.

Treatment Ideas

Identifying left and right is the first step. One activity involves erasing letters with the left hand and numbers with the right. Any activity that involves picking the left or right hand would be a great first step.

The Slap Tap activity is also a great way incorporate visual input and assign a left or right hand. Dr. Boulet and Robert did a video on Slap Tap here. Here is a short example.

Having the child pull letters from a bag and identify the letters without looking at them has been a great activity (suggested by Dr. Charles Boulet) and correlated well with children having difficulty with this task that has reversal problems.

The PDBQ chart is helpful. Initially, starting by just having the child touch the p and b with the right hand and left q and d with the right, corresponding to the side with the “belly”,

Once the child is doing well with this, progress to saying words that start with PDBQ (bad, dad, quick, pop).

Dr. Kenneth Lane OD, FCOVD’s book, Developing Ocular Motor and Visual Perceptual Skills: An Activity Workbook, has an excellent discussion of letter reversals as well as treatment techniques.

Recognition of Reversals Workbook, also by Dr, Lane has more activities for reversals.

Calm the panic!!

In a few cases, letter reversals after the age of 7-8 can indicate dyslexia, but there are many other reasons a child may have reversals. More accurate sign of dyslexia include

difficulty naming letters
difficulty rhyming words
difficulty with producing accurate letter sounds

Learn more about dyslexia here

References

Terepocki, M., Kruk, R. S., & Willows, D. M. (n.d.). The incidence and nature of letter orientation errors in reading disability. Retrieved October 04, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/15493319
McMonnies, C. W. (1992, October). Visuo-spatial discrimination and mirror image letter reversals in reading. Retrieved October 04, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/1430744
Brooks, A. D., Berninger, V. W., & Abbott, R. D. (n.d.). Letter naming and letter writing reversals in children with dyslexia: momentary inefficiency in the phonological and orthographic loops of working memory. Retrieved October 04, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/21978009
Levy, F., & Young, D. (n.d.). Letter Reversals, Default Mode, and Childhood ADHD. Retrieved October 04, 2017, from https://www.ncbi.nlm.nih.gov/pubmed/26794673